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DocuSign Envelope ID:AF213AC7-5247-4BE1-89BB-8589F8088302 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Hazen& Sawyer Party/Vendor Contact Person: James McCarthy Contact Phone: 919-833-7152 <br /> Party/Vendor Address: 4011 WestChase Blvd. City Raleig State: NC Zip: 27607 Department: Planning Amount: <br /> $5,200 Purpose: Lake Orange Dam Inspection Budget Code(s): 10695020-720013 Vendor 4 59201 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 7/29/2015 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> pp DocuSigned by: 1 <br /> ' t�� &'W' )- <br /> iu Date: 7/28/2015 <br /> Department Director's Signatur <br /> 846D10DA3CFD4C2... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> --DocuSignedby: ''1111 <br /> Office of the Risk Management Office AUSS& (hnuh Date: 7/28/2015 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Office C232DFFC2CFA847B m/,L ( byu Date: 7/28/2015 <br /> . <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> ocuSigned by: <br /> Office of the County Attorne 0EAAM33ED8A8465 <br /> bLyu otxfs Date: 2/28/2015 <br /> .. <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 4 <br />